Though its circulation never exceeded a thousand, the English Woman’s Journal attracted an influential readership. One of these readers was Anna Maria Helena Coswell, Comtesse de Noailles, an eccentric and capricious young English widow whose brief and childless marriage to a French count had left her in a position to be extremely helpful to good causes. She was a shareholder in the Journal and let it be known that she was interested in supporting the Blackwells’ work—in England.
It was this tantalizing possibility—a secure medical foothold in Britain, an aristocratic patron, and a chance to take her rightful place among a class of women she admired, including Florence Nightingale, whose fame had so outpaced Elizabeth’s own—that Elizabeth now confided to George. “I think it very desirable to see England again,” she told her brother, “and to test its possibilities.” She had a perfect excuse for deserting the infirmary and indulging in a trip to Europe: her glass eye was giving her trouble, making a consultation with Auguste Boissonneau, the preeminent ocularist who had originally fitted her, a necessity. Though Emily was skeptical of Madame de Noailles’s overtures, Elizabeth ignored her. “I shall pursue the investigation as I think best,” she wrote with autocratic confidence. “I am not sorry either to throw Emily for a while, upon her own resources, and force her into the responsibilities of practice—she has not yet braced herself to the work, as she must eventually, it being her only means of making money.”
Elizabeth was correct that Emily’s commitment to the infirmary was not as absolute as it could be. Beneath the competent composure of the thirty-one-year-old physician was the same frustrated uncertainty that had plagued Emily as a young teacher. Had she won her way to a medical degree, she wondered, only to face a life of lonely and uncredited labor, eternally eclipsed by the aggressive ambitions and prickly personalities of her sister and Marie Zakrzewska? Success as one of the world’s first female physicians, she now understood, would involve more than good doctoring. It would require a constant active cultivation of public support—what the Blackwells referred to, with distaste, as “push.” “An agony of doubt has burnt in my heart for months,” she confided to her journal. Could it be “that this life of a Physician is so utterly not my life that I can not express myself through it—and worse—worse—that I might have done more in other ways?”
Elizabeth’s departure, though it would mean more work for Emily, came at a perfect moment. In Elizabeth’s absence, Emily could manage their project as partner rather than deputy and enjoy a respite from Elizabeth’s brittle moods. “She needs change,” Emily wrote of Elizabeth’s European travel plans. “Her life in many respects would be a much happier one there than here.” And Emily would now have a chance to deepen her own relationships with the patrons and private patients who had come to know Elizabeth first. By the time Elizabeth returned, Emily hoped, “I may have formed the commencement of a practice wh[ich] will enable me to remain here on better terms.” For now, she recommitted herself to the infirmary—where, for the first time, she would be in charge.
On her last ocean voyage Elizabeth had been grateful for the presence of her cousin Kenyon; this time her companion was ten- year- old* Kitty—half ward, half servant—who continued to dispel the gloom of Elizabeth’s habitual solitude. In fair weather the girl promenaded silently at Elizabeth’s side, watching for porpoises and the dark silhouettes of storm petrels, which the sailors called “Mother Carey’s chickens,” while her guardian chatted with the captain and the first mate—who promised to “throw Kitty overboard” if she were seasick.
Elizabeth had sailed for Europe to secure her reputation, not to look after a little girl. Once in London she consigned Kitty to her brother Howard, on leave from India, and her sister Ellen, still abroad to study painting, with instructions to find the child some clothes and deposit her at a boarding school recommended by Barbara Bodichon at Ockham, in the Surrey countryside. “Dear Kittykin,” Elizabeth wrote to her there, her handwriting and syntax enlarged and simplified for the child’s benefit. “The weeks will soon slip away and Doctor will be back to see the progress Kitty has made.” Progress, Elizabeth indicated, should be more practical than intellectual—the new generation of Blackwells, led by the toddlers Florence and Alice, needed looking after. “How nice it will be, when you can cut out little dresses for them, and sew them so fast, while they are playing around.” She sent Kitty a birthday box containing a bonnet, a book, and a skipping rope, then left to visit Anna in Paris.
As an old woman, Kitty still remembered her bewilderment that fall, alone in a new country, surrounded by wary schoolmates who could not categorize this odd Irish-American orphan but were only too eager to eat her share of treacle pudding. Tardiness resulted in a day’s banishment without meals, and as the fall deepened, chilblains bloomed on Kitty’s feet. Her letters of distress to Elizabeth, she discovered with dismay, were never mailed. Finally, on a class excursion to the nearest town, she managed to slip one directly into the postbox, and Elizabeth responded with gratifying speed. That was the end of boarding school, but now Kitty would have to make her way to Elizabeth in Paris, alone.
Howard and Ellen left her at Waterloo Station in the predawn darkness, with a passport in one cloak pocket and a Paris address in the other. A child of means would never have made such a journey without a chaperone, and a girl of the working class would never have traveled at all. Kitty, always betwixt, traveled alone by train to Newhaven, by ferry to Dieppe (a crossing more than twice as long as the Dover-Calais route), and then by train again, arriving in Paris well after midnight. The French station officials, clucking with disapproval over the unsupervised child, tucked her into a carriage, and she rumbled off into the night.
“Having read, small as I was, too much about the Revolution,” Kitty remembered, “I expected to be carried off to the Conciergerie”—the infamous prison that was Marie Antoinette’s last stop before the guillotine. When the carriage halted unexpectedly, she feared the worst. Peeping white-faced out the window, she saw an oncoming cab and heard a familiar voice: “Is that you, child?” Elizabeth, informed that Kitty’s train had arrived, had set out to meet her at the wrong station and caught up with her carriage at last, having recognized the child-sized trunk strapped to the roof. Kitty’s memoir recorded fear and relief, but no blame. Certainly a true bond existed between the doctor and the grateful child she had rescued from the Nurseries on Randall’s Island. But in the letters that survive from their yearlong stay in Europe—during which Kitty began to suffer from vision and hearing problems that would plague her for the rest of her life—Elizabeth makes almost no mention of her.
Her preoccupations were elsewhere. Barbara Bodichon had delivered a formal letter of “heartfelt welcome” signed by more than fifty of the influential Englishwomen in her circle, most notably Lady Byron, inviting Elizabeth to speak publicly on women’s health and the importance of women doctors. Elizabeth was eager to accept, but the lectures she had delivered to Quaker ladies in New York church basements—and subsequently published as The Laws of Life—seemed inadequate for London’s urbane elite. She remained in Paris to rewrite them and try them out on Anna, who, she told Emily, “represents an exaggeratedly English audience.” She also needed to update her wardrobe: perhaps a black velvet hat “to give a little height & importance to the head.” She hesitated at the expense but refused to allow wealthy patrons to underestimate her. “If it all falls through,” she rationalized to Emily, “I shall bring back the clothes & we’ll divide them between us.”
A dignified appearance would also help put her audience at ease—an important consideration, given that her material was likely to make them uncomfortable. In a draft manuscript, she quoted a distinguished London matron who had once exclaimed to her, “You can hardly have an idea of the state of complete ignorance I was in, with regard to everything relating to the body, when I married!” Elizabeth’s first lecture subject, therefore—approached with appropriately “reverential admiration” for an audience strictly limi
ted to women—would be the reproductive organs.
Her explanation proceeded methodically from the almond-shaped ovaries, to the Fallopian tubes—lined with pulsing cilia “like a host of energetic little sweepers to be keeping their house constantly clean”—and onward to the uterus, which expanded from fist-sized quiescence to a “great industrial palace” of muscle and artery during pregnancy. To this point, the anatomy lesson was straightforward, full of domestic and mechanical imagery for these wives and daughters of capitalists. But as she turned to the external structures—vagina, labia, clitoris—Elizabeth’s tone shifted.
“Let me here call your attention to a marked distinction which we observe in the functions of the Genital organs,” she wrote. “We find that the Creator in his supreme goodness & wisdom, while endowing us with senses that place us in communication with the external world,” she continued, “has connected the power of exquisite enjoyment with the proper exercise of those senses.” She detoured into euphemistic metaphor—the flaming glory of the setting sun, the heart-piercing song of a bird, the slaking of a traveler’s thirst with cold water—but soon returned to her point: “We find in the special organization which we are considering, a more abundant provision for exquisite sensation . . . than in any other part of the body.” The clitoris, she pointed out, had no practical function except as a receptor of acute feeling. Her choice of image for female erectile tissue—“a spongy vascular body—in size and form, something like a great swollen leech”—was not unexpected for a woman raised in a culture that regarded sexual desire as a perilous temptation, but the fact that she was addressing physical pleasure at all, that she considered it an important part of a woman’s physiological education, was startling. The women who attended this first lecture would surely return for its two sequels, when Elizabeth would make her larger point about the importance of training female doctors.
Before Elizabeth could take the stage in London, she needed to pay two important calls. The first was to Florence Nightingale, whom she found in January 1859 taking the water cure at Great Malvern. Nightingale had returned from the Crimean War in poor health, bedridden and complaining of chest pain—though she was still managing to churn out reams of cogent testimony on sanitary conditions in the army. Her friends and physicians feared the worst, but Elizabeth was not so sure. “I cannot help thinking that her condition is not understood, and that she is not going to die yet,” she reported to Emily. “She converses with me, precisely as usual, her head clear, her enthusiasm alive, from two to three hours, twice a day.” (Though Nightingale’s invalidism would become part of her mystique, she would live another fifty years. Modern commentators attribute her symptoms to a combination of brucellosis—a bacterial infection acquired at the British camp in Turkey—and emotional health issues including post-traumatic stress disorder.) Public gratitude for Nightingale’s work during the war had ballooned into the forty-five-thousand-pound Nightingale Fund, intended for the training of nurses. Three years after the war’s end, it remained unspent.
All the Blackwells’ fund-raising efforts were a molehill compared to the mountain of money Nightingale now controlled. Her hope, she told Elizabeth, was to establish new standards for nurses, eventually spreading her ideas regarding hygiene to mothers, teachers, and servants across Britain. Doctors, Nightingale felt, tended only to make things worse, interfering with nature’s beneficence—but nurses, if properly taught, had the potential to restore vitality to humanity with attentive hygienic care. “She feels,” Elizabeth wrote to Emily, “that I am the only person in the world that can help her, and she would be immensely relieved from the responsibility of the fund, which weighs heavily upon her, if I would throw [my] life into it.”
Central to Nightingale’s vision was the role of sanitary professor, to be installed in a major London hospital and placed in charge of training the nurses. “She thinks moreover that it ought always to be filled by a woman,” Elizabeth wrote to Emily, “and that woman ought to be an M.D. She thinks I should fill it much better than she.” It was an alluring prospect. The combination of Nightingale’s influence and Elizabeth’s credentials would be potent, and there was considerable overlap in their ideas; both women believed absolutely in the importance of hygiene and education, and Elizabeth frankly preferred the role of professor to that of clinician. But Nightingale’s plan was to improve public health, not to elevate women. “She does not think that England is prepared to educate women Doctors,” Elizabeth wrote. “She would really take me as a valuable exception.”
Elizabeth could not reconcile their divergent perspectives. “She wishes, I see, to absorb me in the nursing plan, which would simply kill me,” Elizabeth confided to Barbara Bodichon. The practice of medicine was Elizabeth’s answer to Margaret Fuller’s call to arms; it made her a model to others, living proof of woman’s true potential, and she refused to give it up. Nightingale, meanwhile, saw the promotion of female physicians as an indulgence. “I remember my impression of your character—that you & I were on different roads (altho’ to the same object),” Nightingale wrote to Elizabeth after her visit. “You to educate a few highly cultivated ones—I to diffuse as much knowledge as possible.” They might have renewed their personal friendship, but on the professional level each would always conclude that the other was missing the point. From New York, Emily summed things up succinctly: “FN’s idea evidently is not to aid you in yr work, but to engage you in hers,” she wrote. “Keep quietly clear of her.”
Elizabeth made her way back across the Channel and southward to the Italian Riviera for her first encounter with Madame de Noailles, another woman who spent most of her time supine—though any similarity to Miss Nightingale ended there. The indolent countess moved through the Mediterranean countryside lounging full-length in an oversized carriage; she retired early, slept late, and enjoyed three extravagant meals during her limited waking hours, with a chamomile-infused bath before dinner. She had exasperatingly little sense of the value of either money or time. “The most characteristic adjective for her is scatterbrain,” Elizabeth wrote to Emily, “impulsive almost to insanity, full of whim.” Elizabeth had intended to give her a private reading of her lectures, but over the course of her five-day visit, she found it impossible to capture the countess’s attention long enough to get through them.
“I can hardly tell you how disgusted I felt by the luxurious self-indulgent objectless life of the wealthy English abroad,” Elizabeth declared†—but Madame de Noailles spoke of giving the Blackwells a small fortune, and for that Elizabeth was willing to look past her excesses. “She has true instincts and certain aspirations which may be relied on,” Elizabeth insisted to Emily—among them “great faith in women, & the desire to help them, and a great interest in the question of health.” Her impulsiveness, in fact, might work to the Blackwells’ advantage. “She told me frankly, she could not bear being bored,” Elizabeth wrote. Regular annual donations were boring, so instead the countess gave Elizabeth a thousand pounds on the spot and the promise of five thousand more, with the expectation that Elizabeth would open a women’s hospital in the English countryside. Buoyed by this windfall, Elizabeth returned to London, ready to win more allies with her newly revised lectures.
Their frank content alarmed even her closest friends. Bessie Parkes thought the ladies would recoil with a “shriek of horror,” but Elizabeth was undeterred: “I simply laugh, and disbelieve her.” On March 2, 1859, she faced her first audience—“about 150 people, of considerable influence”—and even the popular press seemed to approve. “Now, let us for a moment imagine a person intrusted with a complicated and delicate piece of machinery,” noted the popular monthly Chambers’s Journal. “Imagine that person to be ignorant of the principles of the construction of that machine,” it continued—such was the plight of women expected to guard their families’ health in ignorance of physiology. Of course, “in a journal of this character, we can only allude to the more purely medical portion of Dr. Blackwell’s discourse,” the artic
le concluded delicately—but its sympathetic tone was clear: intimate knowledge of physical health, imparted to women by fully trained female doctors, was “subject for much earnest thought.”
One member of Elizabeth’s audience responded with particular earnestness. Elizabeth Garrett, the twenty-two-year-old daughter of a prosperous Suffolk businessman, had read Anna’s profile of the medical Blackwell sisters in the English Woman’s Journal. Inspired by the thought of “something definite & worthy to do,” Garrett attended each of the three lectures with growing interest, attention that was reciprocated once Barbara Bodichon introduced the two Elizabeths. “Last night I saw a Miss Garrett who very much pleased me—a young lady who is quietly forming her determination to study medicine,” Elizabeth reported to Emily. “I think she has the pluck to take it up.” Garrett was not nearly as decided as Elizabeth assumed—“I remember feeling very much confounded & as if I had been suddenly thrust into work that was too big for me,” the younger woman wrote—but to her own surprise, the study of medicine suited her. Six years later she would become the first woman in Britain to qualify as a doctor.
The Doctors Blackwell Page 24